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Rural-urban differences in diagnostic incidence and prevalence of Alzheimer's disease and related dementias
Rahman M, White EM, Mills C, Thomas KS, Jutkowitz E.. Alzheimer's & dementia : the journal of the Alzheimer's Association, 2021-03-04
Topic: Amyloid, tau and blood-test diagnosis
Introduction Understanding rural-urban variation in the diagnostic incidence and prevalence of Alzheimer's disease and related dementias (ADRD) will inform policies to improve timely diagnosis and access to supportive services for older adults in rural communities. Methods Using 2008 to 2015 national claims data for fee-for-service Medicare beneficiaries (roughly 170 million person-years), we computed unadjusted and adjusted diagnostic incidence and prevalence estimates for ADRD in metropolitan, micropolitan, and rural counties, and examined differences in survival rates. Results Risk-adjusted ADRD diagnostic incidence was higher in rural versus metropolitan counties despite lower prevalence. Among beneficiaries diagnosed with ADRD in 2008, metropolitan county residents experienced longer survival compared to residents in rural and micropolitan counties. Discussion These data suggest that older adults in rural communities may be underdiagnosed with ADRD, and/or diagnosed at later stages of dementia. Further work is needed to develop strategies to reduce this disparity.
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APA 7th
Rahman, M., White, E. M., Mills, C., Thomas, K. S., & Jutkowitz, E. (2021). Rural-urban differences in diagnostic incidence and prevalence of Alzheimer's disease and related dementias. Alzheimer's & dementia : the journal of the Alzheimer's Association. https://doi.org/10.1002/alz.12285
Vancouver
Rahman M, White EM, Mills C, Thomas KS, Jutkowitz E. Rural-urban differences in diagnostic incidence and prevalence of Alzheimer's disease and related dementias. Alzheimer's & dementia : the journal of the Alzheimer's Association. 2021. doi:10.1002/alz.12285. PMID: 33663019.
BibTeX
@article{rahman2021-33663019,
author = {Rahman, M. and White, E. M. and Mills, C. and Thomas, K. S. and Jutkowitz, E.},
title = {{Rural-urban differences in diagnostic incidence and prevalence of Alzheimer's disease and related dementias}},
journal = {Alzheimer's \& dementia : the journal of the Alzheimer's Association},
year = {2021},
doi = {10.1002/alz.12285},
pmid = {33663019},
url = {https://doi.org/10.1002/alz.12285}
}
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Key findings
- Results Risk-adjusted ADRD diagnostic incidence was higher in rural versus metropolitan counties despite lower prevalence.
- Among beneficiaries diagnosed with ADRD in 2008, metropolitan county residents experienced longer survival compared to residents in rural and micropolitan counties.
- Discussion These data suggest that older adults in rural communities may be underdiagnosed with ADRD, and/or diagnosed at later stages of dementia.
Why it matters
This study found that risk-adjusted diagnostic incidence of Alzheimer's disease and related dementias was higher in rural than in metropolitan counties despite lower prevalence, and that metropolitan residents with a diagnosis survived longer. The authors suggest that older adults in rural communities may be underdiagnosed or diagnosed at later stages, but the study does not test any treatment, cure, or prevention.
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Study details
- Evidence strengthLow
Limitations
This analysis relies on Medicare claims data and diagnostic coding, which can be affected by how consistently diagnoses are documented and coded differently across rural and urban healthcare settings.
How this study scored 47/100
Published in a leading specialty journal. Scored zero for study design, sample size, effect reported, studied in people and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Alzheimer's & dementia : the journal of the Alzheimer's Association) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 119 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 17.0 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 3 / 6 | Cited 7.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 21 other studies in this library |
| Still being cited | 3 / 4 | Cited 88 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Eric Jutkowitz: h-index 31 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Brown University: institution h-index 1,120 (OpenAlex) |
| Multicenter collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 33663019) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 47 / 100 | — |
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